KMU Past Paper Practice

Question:

A 36-year-old pesticide-store worker becomes dizzy and nauseated after a container spills over his clothes. He is conscious and breathing comfortably. Staff preparing to examine him notice a strong chemical odor. What action should accompany his initial assessment to prevent further exposure?

Give oral activated charcoal immediately

Remove contaminated clothing and wash exposed skin

Induce vomiting before examining him

Apply an occlusive dressing to the exposed skin

Wait for the chemical analysis before decontamination

Correct Answer: Remove contaminated clothing and wash exposed skin

Explanation: Removing contaminated clothing and washing exposed skin limits ongoing absorption and protects staff from secondary exposure.

Question:

A 20-year-old student arrives after swallowing tablets from an unlabelled bottle. Her friend supplies the empty blister strips and reports the approximate ingestion time. She is stable. Which information is most useful for early risk assessment?

Her preferred sleeping position

Her regular dietary pattern

The price of the purchased tablets

The precise drug, possible dose, and ingestion time

Whether the tablets were taken with water

Correct Answer: The precise drug, possible dose, and ingestion time

Explanation: Identifying the likely agent, dose and time helps predict toxicity and select investigations and interventions.

Question:

A 44-year-old patient with suspected poisoning suddenly develops a generalized tonic-clonic seizure in the emergency department. Oxygen and airway support are being provided. Which medication class is generally used first to stop a toxin-related convulsion?

Benzodiazepines

Antipsychotics

Beta blockers

Opioid analgesics

Anticholinergics

Correct Answer: Benzodiazepines

Explanation: Benzodiazepines are first-line agents for most toxicological seizures because they rapidly enhance inhibitory GABA signaling.

Question:

A 31-year-old man has severe vomiting and rapid deep breathing after ingesting an unknown chemical. Arterial blood gas shows pH 7.19 and a low bicarbonate level. Which acid-base disturbance best describes these findings?

Respiratory alkalosis

Metabolic alkalosis

Compensated respiratory acidosis

Primary respiratory acidosis

Metabolic acidosis with respiratory compensation

Correct Answer: Metabolic acidosis with respiratory compensation

Explanation: Low pH with low bicarbonate indicates metabolic acidosis; deep breathing reflects respiratory compensation.

Question:

A 19-year-old woman reports taking extra paracetamol tablets repeatedly over two days for persistent pain. The exact ingestion times are uncertain. Why is a single timed paracetamol nomogram less reliable here?

It applies only to intravenous exposures

It requires a single known-time acute ingestion

It directly measures hepatic synthetic function

It replaces all liver chemistry testing

It is designed for chronic ethanol exposure

Correct Answer: It requires a single known-time acute ingestion

Explanation: The Rumack–Matthew nomogram is intended for a single acute ingestion with a known time, not repeated or uncertain-time ingestion.

Question:

A 26-year-old man began N-acetylcysteine after a significant paracetamol ingestion. On review, the team wants to determine whether hepatocellular injury is developing. Which tests are most directly useful for monitoring hepatic injury and function?

Serum calcium and phosphate

Serum amylase and lipase

Creatine kinase and troponin

ALT/AST and prothrombin time/INR

TSH and free thyroxine

Correct Answer: ALT/AST and prothrombin time/INR

Explanation: Transaminases indicate hepatocellular injury, while INR helps assess hepatic synthetic dysfunction and severity.

Question:

A 33-year-old man who used an illicit stimulant arrives highly agitated with palpitations and elevated blood pressure. There is no severe respiratory depression. Which treatment is most appropriate initially to reduce agitation and sympathetic overactivity?

A benzodiazepine in a monitored setting

Routine flumazenil administration

Immediate naloxone infusion

Pralidoxime administration

Oral N-acetylcysteine

Correct Answer: A benzodiazepine in a monitored setting

Explanation: Benzodiazepines reduce stimulant-induced agitation and sympathetic activation; monitoring and supportive care remain essential.

Question:

A 23-year-old man develops severe muscle pain and dark urine several hours after prolonged agitation following an amphetamine binge. His creatinine has risen. Which process best explains this complication?

Immune destruction of platelets

Isolated hepatic bile duct obstruction

Direct inhibition of vitamin K activation

Acute pancreatic enzyme activation

Skeletal-muscle breakdown causing myoglobin release

Correct Answer: Skeletal-muscle breakdown causing myoglobin release

Explanation: Rhabdomyolysis releases myoglobin, which can injure renal tubules and contribute to acute kidney injury.

Question:

A 48-year-old woman is drowsy after an alleged benzodiazepine overdose. Her ECG is normal, but relatives say she also took an unknown antidepressant. Which reason best supports caution before giving a benzodiazepine antagonist?

It invariably causes liver failure

It prevents oxygen from binding hemoglobin

It may unmask seizures from a proconvulsant co-ingestant

It produces a cholinergic crisis

It irreversibly blocks opioid receptors

Correct Answer: It may unmask seizures from a proconvulsant co-ingestant

Explanation: Flumazenil can precipitate seizures in mixed overdoses involving proconvulsant agents; supportive care is often safer.

Question:

A 55-year-old pesticide sprayer has salivation, wheeze and muscle fasciculations after a suspected exposure. Alongside clinical treatment, which laboratory result supports exposure to a cholinesterase-inhibiting insecticide?

Increased serum lipase activity

Reduced plasma cholinesterase activity

Elevated thyroid stimulating hormone

High serum vitamin B12 concentration

Increased serum ferritin concentration

Correct Answer: Reduced plasma cholinesterase activity

Explanation: Reduced cholinesterase activity supports exposure to an organophosphate, although treatment remains guided by clinical toxicity.

Question:

Two days after initial improvement from organophosphate poisoning, a hospitalized patient develops neck flexor weakness and difficulty breathing despite little bronchorrhea. What complication should be suspected?

Acute withdrawal from ethanol

Delayed carbon monoxide encephalopathy

Anticholinergic delirium

Intermediate syndrome with respiratory muscle weakness

Recurrent methanol intoxication

Correct Answer: Intermediate syndrome with respiratory muscle weakness

Explanation: Intermediate syndrome may develop after the acute cholinergic phase and cause proximal or respiratory muscle weakness.

Question:

A 30-year-old man is being treated for anticholinergic poisoning. He is restless, febrile and unable to pass urine. Which intervention addresses a complication directly caused by peripheral muscarinic blockade?

Assess bladder distension and relieve significant retention

Give pralidoxime for neuromuscular weakness

Give methanol antidote to correct acidosis

Encourage exertion to induce sweating

Administer N-acetylcysteine for liver protection

Correct Answer: Assess bladder distension and relieve significant retention

Explanation: Antimuscarinic effects impair bladder contraction; recognition and relief of significant urinary retention may be necessary.

Question:

A 51-year-old man with acute ethanol intoxication repeatedly vomits while lying flat and becomes increasingly somnolent. What complication is the immediate concern that guides positioning and observation?

Optic neuropathy

Disseminated coagulopathy

Delayed renal stones

Severe hyperthyroidism

Aspiration of gastric contents

Correct Answer: Aspiration of gastric contents

Explanation: Impaired airway reflexes during intoxication make aspiration a major danger, particularly with vomiting and reduced consciousness.

Question:

A 37-year-old patient presents soon after drinking an unknown clear industrial fluid. An elevated osmolar gap is detected, but the arterial pH is initially near normal. Later, a high-anion-gap metabolic acidosis appears. What best explains this evolution?

Immediate irreversible hemoglobin binding

Gradual conversion of a toxic alcohol into acidic metabolites

Progressive muscarinic receptor stimulation

Delayed release of snake venom from the gut

Accumulation of benzodiazepine active metabolites

Correct Answer: Gradual conversion of a toxic alcohol into acidic metabolites

Explanation: Toxic alcohols may initially raise the osmolar gap; metabolism then generates organic acids and a high-anion-gap acidosis.

Question:

A 45-year-old woman recovers from an episode of carbon monoxide exposure and is discharged after appropriate treatment. Her family asks why neurological review is advised despite early improvement. Which late complication is important?

Progressive hemolytic anemia due to vitamin deficiency

Immediate cholinergic muscle fasciculation

Delayed cognitive and neuropsychiatric impairment

Chronic gastrointestinal corrosive stricture

Late venom-induced limb ischemia

Correct Answer: Delayed cognitive and neuropsychiatric impairment

Explanation: Delayed neurological sequelae after carbon monoxide poisoning can include cognitive, behavioral and movement disturbances.

Question:

A rural patient is admitted after a suspected venomous snakebite. He has no active bleeding, but clotting abnormalities are suspected and laboratory access is limited. Which bedside assessment may help detect venom-related coagulopathy when performed correctly?

Random capillary blood glucose

Peak expiratory flow measurement

Direct ophthalmoscopy

20-minute whole blood clotting test

Bedside urinary ketone testing

Correct Answer: 20-minute whole blood clotting test

Explanation: The 20-minute whole blood clotting test can support recognition of venom-induced coagulopathy where suitable laboratory testing is unavailable.

Question:

During antivenom infusion for systemic snake envenomation, a 32-year-old patient develops wheeze, generalized urticaria and hypotension. What is the most appropriate immediate response?

Stop the infusion and treat suspected anaphylaxis promptly

Continue the infusion without reassessment

Perform gastric lavage to remove the antivenom

Administer activated charcoal orally

Apply a tight tourniquet above the bite

Correct Answer: Stop the infusion and treat suspected anaphylaxis promptly

Explanation: Wheeze, urticaria and hypotension during infusion suggest anaphylaxis, requiring immediate treatment including intramuscular adrenaline.

Question:

A 3-year-old child swallows a small amount of kerosene stored in a beverage bottle and then starts coughing. A relative requests gastric lavage. Which risk most strongly weighs against lavage?

Accelerated hepatic conjugation

Severe hyperglycemia

Delayed optic nerve injury

Nicotine-like receptor stimulation

Aspiration causing chemical pneumonitis

Correct Answer: Aspiration causing chemical pneumonitis

Explanation: Hydrocarbon aspiration can cause serious chemical pneumonitis; induced vomiting and gastric lavage increase that risk.

Question:

A patient undergoing carefully selected gastric lavage develops sudden coughing, falling oxygen saturation and respiratory distress. Which complication should the team suspect immediately?

Delayed medication withdrawal

Aspiration of gastric contents into the airway

Progressive vitamin K deficiency

Inhibition of hepatic gluconeogenesis

Hemolysis from carbon monoxide binding

Correct Answer: Aspiration of gastric contents into the airway

Explanation: Cough and hypoxemia during lavage suggest aspiration, a serious procedural hazard requiring immediate airway reassessment.

Question:

The parents of a teenager treated for an accidental household chemical ingestion ask how to prevent another episode. They explain that cleaning liquid was kept in an unlabelled soft-drink bottle. Which prevention advice is most appropriate?

Keep chemicals alongside food for easy identification

Add flavoring so the contents are recognizable

Store chemicals in original labeled containers out of children’s reach

Transfer chemicals into smaller unmarked containers

Rely on verbal warnings without changing storage

Correct Answer: Store chemicals in original labeled containers out of children’s reach

Explanation: Original labeled packaging and secure storage reduce accidental ingestion and improve identification when exposure occurs.